April 10, 2004
Diagnosis and Symptoms, Type 2
Question from Minneapolis, Minnesota, USA:
Because my routine fasting glucose test was 126 mg/dl [7.0 mmol/L] for one test (the second was 93 mg/dl [5.2 mmolL]), and my only glucose tolerance test was 143 mg/dl [7.9 mmol/L] one hour after drinking the solution, my doctor believes that I have diabetes. My understanding, from all I have researched, is that I do not have diabetes until blood glucose levels are 140 mg/dl [7.8 mmol/L] or above two hours after taking the glucose tolerance test. I have been monitoring my own blood glucose levels both before and one hour after meals for three weeks now. None of the pre-meal tests have been above 90 mg/dl [5.0 mmol/L] (most are around 80 mg/dl [4.4 mmol/L]), and none of the post-meal tests, at one hour, not two, have been above 129 mg/dl [7.1 mmol/L]. Most are between 95 and 105 mg/dl [5.3 and 5.8 mmol/L]. I am concerned that my physician is being too aggressive in her approach to treatment. Now she wants to put me on Glucophage. I have two questions: Do I actually have diabetes? And should I being taking drugs before we use diet and exercise for blood glucose control?
Answer:
From the numbers you have provided me, you do not meet the criteria for diagnosis of diabetes. These would include two fasting glucose levels greater 126 mg/dl [7.0 mmol/L] (not 140 mg/dl [7.8 mmol/L]) on different occasions, an oral glucose tolerance test with a two-hour glucose greater than 200 mg/dl [11.1 mmol/L], or random glucose levels great than 200 mg/dl [11.1 mmol/L] on two occasions. There is the classification known as impaired glucose tolerance or pre-diabetes that is noted to have lower cutoffs. Usually fasting is greater than 100 mg/dl [5.6 mmol/L], but less than 126 [7.0 mmol/L] on two occasions. You would also qualify as having pre-diabetes if the two-hour glucose on your oral glucose tolerance was greater than 140 mg/dl [7.8 mmol/L] but less than 200 mg/dl [11.1 mmol/L]. There have been published studies where drugs, such as metformin, have been shown to prevent the onset of newly diagnosed type 2 diabetes. If you have other evidence of risk factors for developing diabetes, the use of metformin in the presence of pre-diabetes has been established.
JTL
